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Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report.

DU C, Li Z, Wang Z, Wang L, Tian YU - Oncol Lett (2015)

Bottom Line: Histology confirmed the diagnosis of adenosquamous carcinoma.The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma.The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China.

ABSTRACT

Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically-confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59-year-old female presented with a cystic mass (15×12×13 mm; volume, 1.3 cm(3)) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm(3) over a period of three months. Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm(3) of yellow-white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.

No MeSH data available.


Related in: MedlinePlus

Magnetic resonance images of the cystic brainstem metastasis taken one week after the onset of symptoms. The tumor was 15×12×13 mm in size (volume, 1.3 cm3) prior to the initial gamma knife radiosurgery. (A) Axial T1-weighted image; (B) axial T2-weighted, fluid-attenuated inversion recovery image; (C) sagittal contrast-enhanced T1-weighted image; and (D) coronal contrast-enhanced T1-weighted image. FoV, field of view; GD-TPA, gadolinium diethylenetriamine pentaacetic acid.
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f1-ol-09-04-1607: Magnetic resonance images of the cystic brainstem metastasis taken one week after the onset of symptoms. The tumor was 15×12×13 mm in size (volume, 1.3 cm3) prior to the initial gamma knife radiosurgery. (A) Axial T1-weighted image; (B) axial T2-weighted, fluid-attenuated inversion recovery image; (C) sagittal contrast-enhanced T1-weighted image; and (D) coronal contrast-enhanced T1-weighted image. FoV, field of view; GD-TPA, gadolinium diethylenetriamine pentaacetic acid.

Mentions: A 59-year-old Chinese female presented to the Department of Neurosurgery, The Affiliated Hospital of Beihua University (Jilin, China) with a two-week history of vertigo and gait instability on May 19, 2012. Magnetic resonance imaging (MRI) revealed a cystic mass located in the pons. The cystic brainstem tumor initially measured 15×12×13 mm (volume, 1.3 cm3), and the cyst wall exhibited annular enhancement (Fig. 1). The patient had undergone surgical treatment for primary lung cancer, pathologically diagnosed as adenosquamous carcinoma, at Jilin Province Cancer Hospital (Changchun, China) two years prior to the current presentation. Brainstem metastases were diagnosed based on the clinical and neuroimaging findings, and the patient received initial GKRS for the lesion in the pons over 40 days. The total radiosurgical dose applied to the tumor was 54.0 Gy in 2 Gy daily fractions. MRI, three months following the completion of GKRS, revealed that the cystic mass had increased in size to 22×17×19 mm (volume, 3.9 cm3) (Fig. 2). The patient was subsequently referred to the Department of Neurosurgery, China-Japan Union Hospital of Jilin University (Changchun, China) for further treatment.


Stereotactic aspiration combined with gamma knife radiosurgery for the treatment of cystic brainstem metastasis originating from lung adenosquamous carcinoma: A case report.

DU C, Li Z, Wang Z, Wang L, Tian YU - Oncol Lett (2015)

Magnetic resonance images of the cystic brainstem metastasis taken one week after the onset of symptoms. The tumor was 15×12×13 mm in size (volume, 1.3 cm3) prior to the initial gamma knife radiosurgery. (A) Axial T1-weighted image; (B) axial T2-weighted, fluid-attenuated inversion recovery image; (C) sagittal contrast-enhanced T1-weighted image; and (D) coronal contrast-enhanced T1-weighted image. FoV, field of view; GD-TPA, gadolinium diethylenetriamine pentaacetic acid.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4356421&req=5

f1-ol-09-04-1607: Magnetic resonance images of the cystic brainstem metastasis taken one week after the onset of symptoms. The tumor was 15×12×13 mm in size (volume, 1.3 cm3) prior to the initial gamma knife radiosurgery. (A) Axial T1-weighted image; (B) axial T2-weighted, fluid-attenuated inversion recovery image; (C) sagittal contrast-enhanced T1-weighted image; and (D) coronal contrast-enhanced T1-weighted image. FoV, field of view; GD-TPA, gadolinium diethylenetriamine pentaacetic acid.
Mentions: A 59-year-old Chinese female presented to the Department of Neurosurgery, The Affiliated Hospital of Beihua University (Jilin, China) with a two-week history of vertigo and gait instability on May 19, 2012. Magnetic resonance imaging (MRI) revealed a cystic mass located in the pons. The cystic brainstem tumor initially measured 15×12×13 mm (volume, 1.3 cm3), and the cyst wall exhibited annular enhancement (Fig. 1). The patient had undergone surgical treatment for primary lung cancer, pathologically diagnosed as adenosquamous carcinoma, at Jilin Province Cancer Hospital (Changchun, China) two years prior to the current presentation. Brainstem metastases were diagnosed based on the clinical and neuroimaging findings, and the patient received initial GKRS for the lesion in the pons over 40 days. The total radiosurgical dose applied to the tumor was 54.0 Gy in 2 Gy daily fractions. MRI, three months following the completion of GKRS, revealed that the cystic mass had increased in size to 22×17×19 mm (volume, 3.9 cm3) (Fig. 2). The patient was subsequently referred to the Department of Neurosurgery, China-Japan Union Hospital of Jilin University (Changchun, China) for further treatment.

Bottom Line: Histology confirmed the diagnosis of adenosquamous carcinoma.The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma.The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects.

View Article: PubMed Central - PubMed

Affiliation: Department of Neurosurgery, China-Japan Union Hospital of Jilin University, Changchun, Jilin 130033, P.R. China.

ABSTRACT

Brainstem metastases have a poor prognosis and are difficult to manage. The present study describes the first case of histopathologically-confirmed brainstem metastasis originating from lung adenosquamous carcinoma, and discusses the outcomes of treatment by stereotactic aspiration combined with gamma knife radiosurgery (GKRS). A 59-year-old female presented with a cystic mass (15×12×13 mm; volume, 1.3 cm(3)) located in the pons, two years following surgical treatment for adenosquamous carcinoma of the lung. The patient received initial GKRS for the lesion in the pons with a total dose of 54.0 Gy, however, the volume of the mass subsequently increased to 3.9 cm(3) over a period of three months. Computed tomography-guided stereotactic biopsy and aspiration of the intratumoral cyst were performed, yielding 2.0 cm(3) of yellow-white fluid. Histology confirmed the diagnosis of adenosquamous carcinoma. Aspiration provided immediate symptomatic relief, and was followed one week later by repeat GKRS with a dose of 12.0 Gy. The patient survived for 12 months following the repeat GKRS; however, later succumbed to the disease after lapsing into a two-week coma. The findings of this case suggest that stereotactic aspiration of cysts may improve the effects of GKRS for the treatment of cystic brainstem metastasis; the decrease in tumor volume allowed a higher radiation dose to be administered with a lower risk of radiation-induced side effects. Therefore, stereotactic aspiration combined with GKRS may be an effective treatment for brainstem metastasis originating from adenosquamous carcinoma.

No MeSH data available.


Related in: MedlinePlus